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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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Signs of severe depression | SKKSPB №1

Depression is also characterized by sleep disorders, which are noted by approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of a sense of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression.

If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems, to admit to “weaknesses”. Quite often, especially in Russia, depressive states are masked by alcohol abuse. In addition, often patients suffering from depression, in order to "shake themselves up", "throw into all serious things", are fond of gambling or extreme sports, leave to serve on a contract in "hot spots". Surrounding people, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, parasitism. Meanwhile, this behavior is a kind of “cry for help”, an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions.

Depressive conditions can occur in shallow forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by:

- ideas of guilt, sometimes reaching the degree of delirium, i.e. unshakable conviction of their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Humanity will perish, that they are “moral freaks” from birth, supposedly deprived of the foundations of morality and a sense of empathy for other people, that they do not places on earth. They find in their past numerous "confirmations" of what has been said, they believe that the doctor and other patients are aware of these sins and express contempt and indignation with their facial expressions and gestures, but in words they "hide, deny the obvious." This must be remembered both to the patients themselves and to their loved ones, in order to prevent an impending threat in time: remove all firearms, piercing and cutting objects, ropes, strong drugs and poisonous household liquids, close windows or shutters, do not let the patient go anywhere alone. persistent character and not amenable to dissuasion, it is urgent to seek advice from a neuropsychiatric institution or call a psychiatrist at home:

- mood swings during the day: in typical cases, the patient, waking up, immediately feels longing. Sometimes, even before full awakening, through a dream he experiences a painful premonition of a heavy coming morning. In the evening, the state of health improves somewhat;

- a person may experience a feeling of unmotivated hostility towards relatives, friends, constant internal discontent and irritation, which makes him unbearable for the family;

- in some people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive, that is, arising against their will, ideas about the misfortunes and troubles of family members come to the fore.

In the next article we will talk about how depression can manifest itself through somatic symptoms.

Material prepared by Stavropol Psychiatric Hospital based on information from the National Center for Mental Health ( http://www.psychiatry.ru ) and WHO.

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How depression turned me into an early bird, and a new approach to sleep turned me into a superhuman

13 August 2018 Health

Entrepreneur Alicia Liu spoke about her experience of dealing with depression and the unexpected effects of sleep restriction.

Alicia Liu

Developer, entrepreneur, vice president of Nava.

Background

For the last six months I have been waking up around 6:30 am, including weekends and holidays. Of course, this is not so early compared to those who get up at five in the morning. But for me, this is a huge change. I literally became a different person. Now I wake up before my alarm and start the day enthusiastically. Before breakfast, I have a whole set of things to do: I meditate, do yoga, ride a bike, read, write, cook oatmeal. It may seem that I am obsessed with my health, but I myself do not quite understand how I came to this.

From childhood I was an incorrigible owl, I loved to read until late at night. Before the invention of tablets and e-readers, I took a table lamp to bed and covered myself with a blanket so that my parents would not notice that I was not sleeping. Around 11 p.m., I usually have a surge of creative energy - this persisted even after turning into a lark. Most of the articles and projects in recent years I have done after midnight.

I work at tech start-ups, and they seem to be specifically designed for owls. No one will look at you askance if you come to work after 10 or even after 11. So, although I went to bed at one or two in the morning, I managed to get 7-8 hours of sleep.

Of course, I knew the benefits of getting up early. But it never crossed my mind to try.

Until I changed jobs. I got a job in a company that improves public services. Because of this, I had to travel every month from San Francisco to the company's headquarters in Washington. Frequent jet lag and increased job responsibilities at a fast-growing startup led to stress and insomnia. And then depression crept in.

How I realized that I had depression

This is not the first time I have experienced depression. In addition, I have been meditating for a long time, so it would seem that I should have recognized the signs of an approaching depression in advance. But no. The brain is great at masking problems with rational explanations.

I associated my pessimistic moods with a realistic outlook on life. Convinced myself that optimists are just being deceived. In addition, the world as I knew it was disintegrating before my eyes. Optimizing public services is incredibly difficult, especially when the President and Congress are actively trying to destroy everything you do. At first, I enthusiastically took up this job, but the motivation began to decline sharply. It doesn't look like me at all.

I was thinking how nice it would be to quit my job and be relieved of my work responsibilities. With difficulty I waited for the end of the working day, already on Tuesday I dreamed about the weekend and thought with fear about work on Sunday evening.

I didn't have the energy to do anything after work. Gradually, I stopped meeting friends and being interested in entertainment. I convinced myself that everything that used to give me joy - traveling, restaurants, photography, writing articles - were just meaningless activities.

Worse, I gave up training because I was constantly feeling tired. And this despite the fact that in a year I have already participated in two sprint triathlons. I began to think that it is not so important whether I live or not. It was then that I finally realized that my brain seemed to be malfunctioning.

It is a common misconception that depression is a state of being very sad. In fact, you just don't care. Sadness implies that you still care about yourself. During depression, it’s hard to force yourself to work, do your hobbies, go somewhere, see people, because you don’t care about all this.

How depression is related to sleep and how I struggled with it

I went to see a doctor and a psychotherapist. At the appointment, it became clear to me that I had insomnia. This is a sleep disorder in which it is difficult to fall asleep or not wake up for several days. The symptoms of depression and insomnia mutually reinforce each other.

By that time I had been having trouble sleeping for many weeks. Although I went to bed very early, I did not fall asleep for a long time. I was tormented by anxious thoughts about work. I constantly felt tired, and this only exacerbated the depression.

I knew I had to do something, but I didn't want to take sleeping pills. After sedation, the next day you feel like a zombie. At one time, I worked with a company that was studying the effects of medical marijuana on various conditions, including insomnia. It doesn't have the side effects of sleeping pills. I took advantage of the fact that I live in California and went to the doctor to get permission to buy medical marijuana.

In the US, it is classified as a banned substance, so there is very little reliable information about its properties. I had to experiment to understand how much I need to fall asleep. It's not at all as pleasant as it sounds. I don't smoke, and making tinctures seemed too complicated for me. Therefore, I settled on food products with the addition of marijuana. Their action occurs only after a few hours, so it is very difficult to choose the right time to take and dose. Other food eaten also affects the effect. However, it became easier for me to fall asleep. Only insomnia has not gone away.

I still woke up around 4 or 5 am and couldn't sleep anymore because of anxious thoughts. Sometimes I managed to fall asleep again, but in the morning I still felt lethargic and tired.

Marijuana inhibits REM sleep, which is essential for memory and other important brain functions. It is suitable as a temporary solution, but does not provide sleep that truly restores the body. I knew that I needed to learn to sleep naturally. It was around this time that I came across information about cognitive behavioral therapy for insomnia (CBT-B).

How CBT works for insomnia

The body has a natural need for sleep. He knows how to sleep. Small children and animals do not suffer from insomnia. Adults have trouble sleeping because they think too much.

According to CBT-B, our thoughts are the main cause of depression and anxiety. And if you replace negative illogical thoughts with positive and realistic ones, mental health will improve. And in order to change your thoughts, you need to change your behavior.

Before that, I thought, like most people: if I don't get enough sleep, then I need to sleep more. I went to bed earlier and stayed in bed longer. CPT-B suggests the opposite approach: to get enough sleep, you need to sleep less than .

Sleep time and just time in bed are not the same thing. The ratio of these two numbers reflects the efficiency of your sleep.

I went to bed at 23 and got up at 8, but slept only 5-6 hours. That is, my sleep efficiency was only 5/9or 55%, and ideally you need more than 90%. No wonder I was so tired.

To change a habit, you first need to observe it. This also applies to sleep. CBT-B specialists advise tracking your sleep two weeks before starting therapy and keeping a special sleep log. In this case, you can not take sleeping pills. I did not want to suffer without sleep for another two weeks, so I immediately began therapy. And I tracked my sleep using the Apple Watch app. This method is not as reliable as handwriting, but it was enough for me.

CBT-B includes improving sleep hygiene and getting rid of negative thoughts about it. It is based on two behavioral strategies: stimulus control and sleep restriction. They can be used individually or combined. I decided to combine. The downside is that you need even less sleep. For almost a month I was very, very tired. This is extremely unpleasant, but you get the result faster.

Stimulus control

It teaches to associate the bed only with sleep. For this:

Go to bed only when you feel sleepy. Not just when you're tired, but when your eyes close, your head bows and you begin to nod off.
If you are still awake after 15 to 20 minutes, get up and go to another room until you feel sleepy again.
Don't do other things in bed: don't read, don't work, don't correspond, don't watch TV. The only exception is sex.

Sleep restriction

This strategy assumes that you need to spend as much time in bed as the body is able to sleep. To do this:

Determine how much time you sleep using your sleep observations. When I started practicing this method, I got about five hours of sleep per night. This exercise helps you see that we usually sleep longer than we think.
Calculate what time you need to go to bed. It all depends on how much you sleep and when you need to get up. I wanted to get up at 6:30, it turns out that I needed to go to bed only after one in the morning. Give yourself some time to fall asleep. No matter how tired you are, go to bed only at the calculated time. You should aim for 90 percent efficiency, that is, almost all the time in bed should be occupied by sleep.
When sleep efficiency exceeds 90% during the week, increase time in bed by 30 minutes. If you get more sleep next week, go to bed another half an hour earlier, and so on. But if your sleep efficiency starts to decline, reduce your time in bed again.

Sleep only in bed and nowhere else. Don't take a nap and consume less caffeine. But most importantly, get up at the same time every day, even on weekends. At first it was very difficult: I always liked to lie around longer on non-working days. But since I still didn’t get enough sleep, I decided to try it. I am sure that as a result it helped me to improve the quality of sleep.

Results

The most amazing and important thing I have learned in therapy is not how to sleep more. My sleep time has increased to six and a half hours. But sometimes there were still nights when I slept for 5-6 hours, and this is much less than the recommended 7-8. At the same time, I helped myself in every possible way:

I did yoga poses, lit scented candles, took a hot bath to relax before going to bed.
Bought nice cotton sheets, a duvet and linen bed sheets to make her sleep more comfortable.
I sewed thick curtains myself, because the finished ones were too narrow for our window.
After consulting a doctor, I bought a special phototherapy lamp that regulates the production of melatonin. I didn't notice any effect. If you have insomnia, do not start treatment with a lamp yourself: improper use can only worsen the symptoms.
I kept an anxiety diary to organize the thoughts that prevented me from sleeping. Every morning for 10 minutes I wrote down everything that bothered me. You have to write before the time runs out. Try it if you suffer from anxiety.
Bought glasses with yellow lenses that protect from the blue light of the screens. I put them on every night around nine.
And the most useful thing is that I started exercising regularly again. I signed up for a triathlon with a friend, it gave me motivation. Exercise itself is effective in treating insomnia and depression.

Even though I've been doing this for half a year, I still get less than seven hours of sleep. And I feel great! Because, in addition to a change in habits, I also had a change in thinking.

I thought I needed about eight hours of sleep in order to feel good the next day, be productive and energetic - but this is not true.

When I gave up this belief, I began to enjoy life much more. As soon as my anxiety about not sleeping stopped, the depression also went away. This was during the first week of therapy. As I later learned, sleep reduction is used to treat depression along with antidepressants.

Personal findings

As you can see, during this therapy you begin to behave a little strangely. If you wake up in the middle of the night, you need to get out from under the covers and do something boring until you feel sleepy again. But when I realized that the body itself would fall asleep as soon as it was ready, I accepted these oddities. When I was up at night, I listened to podcasts and audiobooks, did household chores, and played with my cats. In order not to suffer so much, getting out of a warm bed, I put on a cozy sweater and slippers.

Difficulties with sleep and insomnia do not come from lack of sleep, but from anxiety about not getting enough sleep.

Since I went to bed late to limit my sleep to the hours I needed, I had extra free time. I watched a lot of TV series and read a lot of management books. Both pleasure and benefit!

If you are not sleeping alone, there are additional difficulties. My husband practically stopped seeing me in bed. I go to bed when he is already fast asleep, and I get up much earlier than him. Be sure to discuss how the new sleep routine will affect your relationship. I hope your partner will notice that you are becoming happier and more energetic, and will treat the changes with understanding. Replace falling asleep together with some other activity that strengthens your bond.

The most noticeable effect of therapy was on my mood. Of course, there are still nights when I wake up too early and can't get back to sleep. But now I do not indulge in anxious thoughts, but benefit from additional free time.

Ever since I started CBT for insomnia, I feel almost superhuman.

I started seeing meaning in my work again and became much more productive. I'm speaking at two conferences this year, although just recently I thought I wouldn't be able to speak in front of an audience.

I became hypersociable and learned to recharge my energy from interacting with people. I began to value time with friends and conversations with strangers more. I have become a real triathlete and train almost ten hours a week. I took eighth place in my age category in the sprint triathlon and now I am preparing for the Olympic distance. If I used to be intimidated by the thought of swimming 1.5 kilometers, cycling 40 and running 10 more, now I am overwhelmed with enthusiasm.

I started writing articles again after a two-year hiatus. I don't know what to do with the surge of creative energy.

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